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As most diet therapy texts provide little information about psychiatric illnesses and their treatment, this article is intended as a brief introduction for dietitians. Several psychiatric illnesses, including schizophrenia, mood disorders, eating disorders, and substance abuse, may adversely affect food intake and nutritional status. The drugs used to treat those disorders similarly have effects on appetite and gastrointestinal function and interact with food and nutrients. Antipsychotics, antidepressants, and monoamine oxidase inhibitors (MAOIs) cause dry mouth, constipation, and weight gain. Lithium may cause nausea, vomiting, diarrhea, polydipsia, and weight gain. MAOIs have well-known interactions with foods containing tyramine. Lithium interacts with dietary sodium and caffeine; decreasing dietary intakes of those substances may produce lithium toxicity. Despite claims to the contrary, major psychiatric illnesses cannot be cured by nutritional therapies alone. Dietitians can, however, play an important role as part of a multidisciplinary team in the treatment of patients with psychiatric illness. Such a role includes nutrition assessment and monitoring, nutrition interventions, patient and staff education, and some forms of psychotherapy, including supportive and behavioral therapies for patients with eating disorders.
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PMID:Nutritional aspects of psychiatric disorders. 267 98

17 hyperprolactinemic and 2 acromegalic patients, aged 19-73, and 47 and 59 years, respectively, were treated with Lisuride (dopergin). 12 of the hyperprolactinemic patients were treated with Lisuride because they could not tolerate the side effects of bromocriptine (Group A), and the other 5 because large doses of bromocriptine failed to reduce their plasma prolactin to normal (Group B). The 2 acromegalic men, were treated with Lisuride because of persistently high levels of growth hormone after hypophysectomy and irradiation of the sella turcica, and because of intolerance to bromocriptine. Lisuride reduced prolactin to normal in 11 of the 12 in Group A (from 217 +/- 175 to 27 +/- 10 micrograms/l, p less than 0.01) and reduced it in the last patient from 3900 to 270 micrograms/l. The prolactin-lowering effect of Lisuride was unsatisfactory in Group B since like bromocriptine, it failed to reduce prolactin levels. One of the acromegalics improved both clinically and biochemically and growth hormone levels were reduced from 56 to 18 ng/ml, while the other did not respond to Lisuride. Its main side effects were somnolence, nausea, and increased appetite (4 patients). These effects lasted only a few weeks. One patient stopped Lisuride because of severe constipation, which had been caused by bromocriptine as well. Lisuride is an effective drug in hyperprolactinemia, especially in those with severe side effects after other dopaminergic drugs. It is effective in some cases of acromegaly, but has little to offer to those resistant to bromocriptine.
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PMID:[Treatment of hyperprolactinemia and acromegaly with lisuride]. 279 46

A modified version of the McCorkle & Young Symptom Distress Scale, based on a linear analogue self-assessment scoring system, was used to assess symptom distress in a heterogeneous sample of 53 cancer patients. The scale was simultaneously completed by the nurses caring for those patients, who were asked to rate the patient according to how they perceived he was feeling with regard to each particular symptom. The scores were compared for congruency. This preliminary study suggests that, although nurses appear able to estimate the degree of distress due to changes in mobility and appearance or the presence of diarrhoea, constipation and tiredness, they are less effective in perceiving the degree of distress due to the less 'visible' symptoms such as pain, nausea, anorexia, sleeping disturbances, concentration and mood. Perhaps surprisingly, the trend was for nurses to overestimate the degree of distress when this was compared with the patients' self-assessment.
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PMID:Patients' and nurses' perceptions of symptom distress in cancer. 280 38

In this prospective study, we investigated the relationship between dietary practices and pregnancy discomforts among 50 urban black American women during their first and third trimesters of pregnancy. Subjects were interviewed during their regular prenatal clinic visits for information about their previous 24-hour dietary intake, the presence and severity of pregnancy discomforts occurring in the previous month, and pertinent demographic data. Findings indicated that high intake of meat products but low or no intake of vegetables was correlated with nausea, little or no intake of milk products was correlated with heartburn, and low or no intake of citrus fruit but intake of vitamin and iron supplements was correlated with heartburn, constipation, and sleeping difficulty. Replication of the study with a larger sample is warranted so as to provide further validity to the findings.
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PMID:Dietary practices and pregnancy discomforts among urban blacks. 280 80

The case is reported of a 47 year old female patient admitted with asthenia, anorexia, nausea and constipation. The poor clinical features contrasted with the severe biological disturbances: 1 mmol.l-1 serum potassium, pH 7.26, 19 mmHg PaCO2, 8 mmol.l-1 bicarbonate, myoglobinaemia and myoglobinuria. The electrocardiogram showed a flattened T wave, an U wave, and a depressed ST segment. Potassium was given intravenously at a rate of 0.38 mmol.kg-1.h-1 during the first 24 h. Renal biopsy confirmed the diagnosis of distal renal tubular acidosis, but no aetiology could be found. This patient's excellent clinical tolerance of a severe hypokalemia suggested that the potassium pool could be replaced at slower rates than those suggested in the literature for patients with severe symptoms and signs.
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PMID:[Severe hypokalemia with few symptoms disclosing distal renal tubular acidosis]. 281 44

A previously healthy 50-year old man presented with acute small bowel obstruction. No etiology was found at laparotomy. Postoperatively, the patient remained symptomatic with nausea, vomiting and severe constipation. Gastroscopy revealed retained food in the stomach. Gastric emptying of solids and liquids was dramatically decreased at scintigraphy. The colon was dilated on X-ray study. Chest X-ray revealed a pneumopathy and a small-cell lung cancer was discovered at bronchoscopy. The patient died 5 months after onset. Histologic study of the gut showed widespread degeneration of the myenteric plexus with plasma cell infiltration, Schwann cell proliferation and a reduced number of neurons of which many were abnormal. Intestinal pseudo-obstruction can reveal a small-cell lung cancer; the mechanism of neuronal impairment leading to pseudo-obstruction remains unknown, but could be related to the pathophysiology of paraneoplastic syndromes.
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PMID:Paraneoplastic intestinal pseudo-obstruction as the presenting feature of small-cell lung cancer. 283 68

A 34-year-old native women presented as an acute abdominal emergency at the Surgery Department, Missionary Hospital "Ad Lucem" in Banka-Bafang, Cameroon. She complained of colicky, epigastric abdominal pain, nausea, vomiting, constipation, and retention of flatus. At laparotomy, numerous small cystic nodules (3-8 mm in diameter) were noted in the mesentery and under the intestinal and parietal peritoneum. Histological examination of two of them revealed slightly enlarged mesenteric lymph nodes containing several parasitic pseudocysts. The parasites were diagnosed as well-preserved, encysted, Armillifer armillatus nymphs. Neither degenerative nor inflammatory granulomatous reactions were observed in the adjacent tissue. Two and a half years later, a similar attack of acute abdominal symptoms recurred. A radiological examination revealed several C-shaped or circular, dense opacities characteristic of calcified pentastomid nymphs. At laparotomy, local findings similar to those at the previous surgical examination were noted. Additionally, a few firm, whitish, calcified nodules were found in the mesentery and under the fibrous capsule of the liver.
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PMID:Pentastomiasis: case report of an acute abdominal emergency. 286 82

Successful management of pain can be accomplished in nearly all terminally ill patients. Pain must be assessed in terms of its physical, psychological and social components. Spiritual care and control of environmental factors are just as important as drug therapies. Once the cause of the pain is identified, an individualized plan of treatment can be developed. Nondrug therapies are tried first. When drugs must be used, the pain is treated by regular dosing to prevent recurrent breakthroughs--no PRN orders are used. The pain is blocked and its memory erased so that continued, uninterrupted relief is given. Drug management should provide ease of administration to maintain patient independence, unclouded and normal affect, and minimal troublesome side effects. Anticipatory treatment of expected problems with constipation and nausea should be done. By using a reproducible pain measurement scale, titration of drugs is carried out in a stepwise fashion, increasing dosage or potency until the desired effect is achieved. With multimode therapy, no patient should have to suffer the aching/agony pain cycle of terminal illness with cancer.
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PMID:Pain management. 288 74

The opioid agonist-antagonists are a heterogeneous group of compounds capable of providing analgesia sufficient to treat moderate to severe acute pain. Pentazocine, butorphanol and nalbuphine produce subjective effects which are quite different from those of morphine. Lack of mood elevation and occasional dysphoria may contribute to a lower level of patient acceptance, but all of these analgesics are significantly safer than the pure agonists. Doses in the therapeutic range are unlikely to produce dangerous levels of respiratory depression in most patients. Other opioid side-effects such as nausea, constipation and biliary spasm appear to be less frequent as well. The mu partial agonist buprenorphine shares many of the safety advantages of the older drugs, and its subjective effects appear more morphine-like. It is not clear whether mu partial agonists have real clinical advantages over kappa-type analgesics. All of these drugs are opioid antagonists and are able to precipitate abstinence in individuals with significant prior exposure to opiates. Neither absolute potency nor the ratio of agonist to antagonist effect are predictors of therapeutic usefulness. There is now an enormous amount of clinical experience with the agonist-antagonists. In many, but not all, clinical situations they are acceptable alternatives to the morphine-like drugs.
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PMID:The clinical usefulness of agonist-antagonist analgesics in acute pain. 289 87

A nutritional assessment including determination of symptoms potentially influencing weight loss was prospectively performed on 254 consecutive cancer patients with favorable performance scores (Eastern Cooperative Oncology Group [ECOG] level 0 to 2). Primary cancer sites included the following: non-small cell lung (n = 93), colon (n = 50), prostate (n = 23), oropharyngeal (n = 18), breast (n = 15), gastrointestinal (n = 13), and other (n = 42). Thirty-nine percent of patients had received no prior chemotherapy or radiation therapy. Common symptoms in the population were abdominal fullness (61%), taste change (46%), constipation (41%), mouth dryness (40%), nausea (39%), and vomiting (27%). Current caloric intake was surprisingly similar in 170 patients with weight loss (percent usual body weight [PUBW], less than or equal to 95%) compared with 84 without weight loss (PUBW, greater than 95%; 31.4 +/- 1.5 versus 30.5 +/- 2.1 kcal/kg/d, respectively). Symptoms identified by multivariate analysis as occurring significantly more frequently in populations with weight loss included abdominal fullness (P less than 0.001), taste change (P less than 0.002), vomiting (P less than 0.005), and mouth dryness (P less than 0.02). There was no difference in frequency of symptoms between patients with or without prior chemotherapy. These results indicate that gastrointestinal/oral symptoms potentially influencing weight loss are prevalent early in the course of cancer patients with unresectable disease, regardless of current nutritional status, caloric intake, or prior therapy experience.
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PMID:Symptoms potentially influencing weight loss in a cancer population. Correlations with primary site, nutritional status, and chemotherapy administration. 291 Apr 38


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